| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
9,720 |
7,687 |
$355K |
| D1206 |
Topical application of fluoride varnish |
3,476 |
3,418 |
$67K |
| 90651 |
|
2,153 |
1,760 |
$55K |
| 99401 |
|
2,186 |
1,701 |
$53K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,515 |
2,469 |
$46K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,625 |
1,859 |
$36K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,073 |
835 |
$35K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,286 |
871 |
$24K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
679 |
515 |
$23K |
| D1120 |
Prophylaxis - child |
584 |
571 |
$18K |
| 81025 |
|
4,113 |
2,976 |
$16K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
241 |
186 |
$14K |
| 90716 |
|
1,527 |
1,072 |
$12K |
| J7307 |
Etonogestrel (contraceptive) implant system, including implant and supplies |
27 |
24 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,037 |
787 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
102 |
80 |
$5K |
| 87905 |
|
1,076 |
903 |
$5K |
| 90715 |
|
1,777 |
1,593 |
$5K |
| 87808 |
|
1,241 |
1,021 |
$4K |
| 99402 |
|
110 |
65 |
$4K |
| 90734 |
|
1,191 |
1,016 |
$3K |
| 90707 |
|
1,234 |
838 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
135 |
129 |
$3K |
| 90670 |
|
2,464 |
1,813 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
86 |
85 |
$1K |
| D1354 |
|
216 |
66 |
$1K |
| 90686 |
|
926 |
691 |
$1K |
| 11981 |
|
13 |
12 |
$1K |
| 99201 |
|
48 |
27 |
$798.38 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$692.76 |
| 90688 |
|
48 |
38 |
$663.33 |
| 90619 |
|
267 |
231 |
$580.00 |
| 90677 |
|
31 |
30 |
$510.00 |
| 90620 |
|
14 |
14 |
$330.75 |
| 90633 |
|
2,633 |
2,106 |
$310.00 |
| 90680 |
|
715 |
476 |
$170.00 |
| 90723 |
|
346 |
255 |
$150.72 |
| 90658 |
|
48 |
35 |
$150.10 |
| 90700 |
|
505 |
396 |
$127.40 |
| 90713 |
|
439 |
381 |
$98.77 |
| 90710 |
|
1,267 |
1,184 |
$79.22 |
| 87210 |
|
28 |
12 |
$49.89 |
| 36415 |
Collection of venous blood by venipuncture |
15 |
12 |
$23.46 |
| 90648 |
|
216 |
148 |
$17.37 |
| 90696 |
|
732 |
605 |
$0.00 |
| 90744 |
|
1,096 |
824 |
$0.00 |
| 99000 |
|
3,727 |
2,818 |
$0.00 |
| 90698 |
|
1,283 |
926 |
$0.00 |
| D0603 |
|
92 |
91 |
$0.00 |
| 90697 |
|
100 |
89 |
$0.00 |
| D1330 |
|
72 |
72 |
$0.00 |
| 90647 |
|
75 |
48 |
$0.00 |
| 90661 |
|
19 |
15 |
$0.00 |
| 90671 |
|
57 |
55 |
$0.00 |